THE PFC MATRIX

ED Marie T. Cruz MD DFM

 OBJECTIVES
• 1. to discuss core concept of biopsychosocial approach as it relates to the kind of care in
family practice
• 2. discuss the integration of the BPS in actual patient care using the PFC matrix
 THE PFC MATRIX
• THE PFC MATRIX is a tool to enhance understanding of doctors on the
biopsychosocial approach to care

• Appropriate interventions be made to improve patient adherence to medical care, and promotes
better patient outcomes

• Necessary and appropriate family and community interventions are developed- minimize cost of
treatment, efficient delivery of health services and implementation of relevant ( apolitical ) health
services
 THE PFC MATRIX
• The PFC Matrix has been developed by Zorayda E. Lepando in n2000 to help residents
understand the biopsychosocial approach using a clinical case they encountered in their
clinical rotations
• The matrix is founded by 3 key components of BPS, namely patient centered, family
focused and community oriented approach of health care
 THE MATRIX
components Patient centered Family focused Community oriented
data Relevant clinical histories, Physical findings, Assesment of family psychodynamics Assessment of social determinants of
context of psychosocial issues, such as using family assessment tools, family health and building blocks of a health
emotions relevant to the health condition systems assesment system relevant to the presented
medical and psychosocial issues of the
including bioethical issues case
analysis Salient clinical features and psychosocial Salient features of the family Salient features of the assessments of
bioethical issues dynamics and /or family systems the social determinants and building
assessment blocks of the health system
Diagnosis/ Medical diagnosis Summary statements of the issues Summary statements of the issues
Psychosocial diagnosis identified in the assessment identified in the assessments done
conclusion ( using ICD V codes) done( health enabling and barriers to ( both enabling and barriers of care
asssumptions care
Management Comprehensive medical intervention based on Family interventions to address both Interventions (COPCbased) to address
evidence and standards of care ( encompassing all medical and psychosocial issues the issued identified ( existing and
interventions levels of care identified proposed
Individual psychosocial intervention such as the
psychoeducational approach(CEA)motivational
and behavioral counseling appropriate to address
identified issues
 PERSPECTIVE INFLUENCERS OF
OUR PATIENTS

• CULTURE
• INFLUENCES OF OTHERS
• EDUCATIONAL BACKGROUND
• HEALTH BELIEFS
• PRIORITIES
• EXPERIENCES
 FACTORS AFFECTING HEALTH

• CULTURE
• GOVERNMENT
• Status
• Human resources
• Governance
• Educational attainment
• health SYSTEMS
 V CODES (ICD 10)
• V15.81NONCOMPLIANCE WITH MEDICAL TREATMENT
• V60.0 LACK OF HOUSING
• V60.1 Inadequate housing
THE PERSPECTIVE

From BIOPSYCHOSOCIAL

TO

SYSTEMS THINKING
SYSTEMS
THINKER
 LESSONS FROM ANATOMY
PARTS

• PARTS HAVE FUNCTIONS

• PARTS WORK TOWARD A GOAL= SURVIVAL

• PARTS COMMUNICATE WITH OTHER PARTS

• NEED AN ORGANIZER
 THE SYSTEMS APPROACH
• Uses TRIAXIAL DIAGNOSIS

• BIOLOGICAL
• PSYCHOLOGICAL
• SOCIAL PERSPECTIVE
 GOAL

• 3 SOCIAL SYSTEMS- PERSON, FAMILY, COMMUNITY

PERSON- lifestyle and behavior, screening, vaccination, chemoprophylaxis

FAMILY- family systems, family life cycle, family dynamics and impact of illness

COMMUNITY- health care delivery systems, social determinants, environment, culture,

economy, politics, community development
• THINK IN SYSTEMS
• EXAMPLE

THIS IS A HEAP THIS IS A SYSTEM

 MATRIX USE
PATIENT CENTERED
FAMILY FOCUSED PATIENT FAMILY COMMUNIT
Y
COMMUNITY ORIENTED
DATA
(GATHERING
ANALYSIS

ASSESSMENT

MANAGEMENT
DATA GATHERING

JIGSAW PUZZLE
ANALYSIS

ASSESSMENT

MANAGEMENT
PICTURE
 PATIENT CENTERED
• A type of care that is closely congruent with and responsive to patient’s wants need and
preferences
• Includes relevant clinical histories
• Physical findings
• Context of psychosocial issues such as emotions attendant to the health condition including
bioethical issues
 PATIENT –CENTERED
• PATIENT CENTERED METHOD
1. Explore and interpret both the disease and illness experience
2. Understand the whole person
3. Find common ground with the patient about the problem and its management
4. Incorporate prevention and health promotion
5. Enhance the doctor –patient relationship
6. Be realistic about time and resources
 Patient – centered care

Data General data about the index patient, story of disease and illness, thoughts
feelings and behavior

Analysis Salient features of the case

Medical=disease
Psychosocial= illness experience

Assessment Identification of the problem

Management planned intervention

 PATIENT CENTERED
MANAGEMENT INTERVENTIONS
A. Comprehensive medical management
• evidence based practice guideline
• Use of promotive and preventive intervention

B. Psychoeducational intervention to change risky behaviours and non adherence

• primary care counseling
 FAMILY FOCUSED PRIMARY CARE
• Identifying family at risk
• The importance of GENOGRAM
• the family within a larger system- use the ECOMAP / SCREEM

• Chronic illness and disability- supporting FAMILY CAREGIVERS

• Working with family members- the FAMILY CONFERENCE
 •FAMILY SYSTEMS THEORY
EMPHASIZES THE
INTERCONNECTEDNESS OF HUMAN
BEINGS IN THEIR INTIMATE
ENVIRONMENT
 FAMILY SYSTEMS CONCEPTS

• The family is more than just a collection of

individuals
• Families have repeating patterns that regulate
member’s behavior
 DATA INCLUDED IN THE MATRIX
OF FAMILY FOCUSED CARE

• Assessment of family psychodynamics

• Family assessment tools
• Family systems assessment
 TOOLS FOR FAMILY ASSESSMENT
• The family lifeline-history of resilience
• The Family APGAR-level of functionality
• The Family MAP- the current situation
• The Family SCREEM- barriers and resources to family goals
• The family ECOMAP- resources in the community
 REVIEW : AREAS OF ASSESSMENT

• 1. structure; roles, rules, transactional patterns

• 2. flexibility- ability to adapt
• 3. resonance- degree of emotional reactivity from enmeshed to disengaged
• 4. Ecological context- SCREEM
• 5. development- family life cycle
 FAMILY FOCUSED INTERVENTION
• Family health education and counseling
• Family meeting
• Home visit

• Goal: is to enable the family to contribute to the CARE OF FAMILY

MEMBER who is sick and decrease their potential of health risk
 THE FAMILY MEETING

• Rationale
A family conference does not imply family dysfunction… but it
does imply a need for some change in family rules and habits and
the need for improved communication to meet the crisis
 RATIONALE
• Gathering information
• Health education/ disclosure
• Decision making and planning
• Discussion and prognosis
• Provision of support
 A FAMILY ECOMAP

• IDENTIFYING THE RESOURCES IN THE

COMMUNITY WHERE THE FAMILY RESIDES
 THE FAMILY ORIENTED DOCTOR
• Gathers information about the index patient and identifies medical problems
• Gathers the family data in order to contextualize the patient’s illness
• Utilizes the needed tools used in family Medicine
• Analyses the psychosocial impact on the family
• Provides the needed intervention
 SPECTRUM OF CARE
Minimal emphasis on the family Biomedical issues are the sole conscious focus of patient care
Ongoing medical information and Primarily medical with awareness of the triangular dimension of the
advice physician patient relationship
Feelings and support Knowledge on normal family and reaction to stress
Systematic assessment and planned Systematically assessing the family system and reframing the family’s
information definition of their problem in a way that makes problem solving more
achievable
Family therapy Handling intense emotions in families and constructively dealing with a
family’s strong resistance to change
• How far can you go?
 PAFP STANDARDS OF CARE
• Indicators of a healthy family
• Members are as physically and mentally fit as they can be- able to be
functional, grow and develop
• Communication among family members is open and misunderstandings are
minimized
• The family as a unit is able to cope with acute or chronic stressors and adapt to
needed changes
 Family oriented care

Data (tools needed) General data about the family, genogram, lifecycle, illness trajectory,
system, rules, roles, patterns Family APGAR

analysis Family MAP, family psychodynamics

assessment Identification of the problems as it relates to the medical problem of the

index patient

Management Planned intervention, Family goals- immediate and long term

 THE COMMUNITY
• What is community oriented as applied in the PFC
matrix?
• links the individual health to community health
• orientation of clinical practice to promote health prevent disease alleviate
the suffering and disability
• continuity of care- health facility, family and community where the
patient lives
 WHAT IS INCLUDED IN THE
COMMUNITY MATRIX?

• Epidemiologic data of the disease burden

• Common social determinants affecting the disease
• WHO building blocks- focused on the need of the index
patient
 SOCIAL DETERMINANTS OF
HEALTH
• Age sex and constitutional factors
• Individual lifestyle factors
• Social and community networks
• Agriculture and food production, education, work environment,living
and working conditions, unemployment, water and sanitation, health
care services housing
• General socio economic, cultural and environmental conditions
 6 BUILDING BLOCKS OF THE
HEALTH SYSTEM

• Leadership and Governance

• Health systems Financing
• Health Service delivery
• Human resources ( health workforce)
• Health information systems
• Access to essential medicines
 COMMUNITY ORIENTED
DATA GENERAL DESCRIPTION OF THE COMMUNITY

ANALYSIS SOCIAL DETERMINANT OF HEALTH, HEALTH SYSTEM

RESPONSE TO HEALTH, PROBLEMS IDENTIFIED IN THE
COMMUNITY
ASSESSMENT IDENTIFIES THE PROB LEMS AS IT RELATES TO THE PATIENT.
HEALTH SYSTEM DETERMINANTS

MANAGEMENT INTERVENTION- NETWORK

 COMMUNITY ORIENTED
MANAGEMENT INTERVENTIONS

• CARE NAVIGATION AND COORDINATION

• disease –based group intervention
• patient support groups
• government ang non government led health services and programs
• DESIGN POPULATION BASED SERVICES FOR HEALTH
PROMOTRION
• people initiated programs
 SUMMARY TABLE
Patient centered Family focused Community oriented
Data gathering History PE, thoughts and Family history, Family family Family ecomap, social determinants
feelings ( fears, concerns, determinants and resources,
doubt,predicament) caregiver issues, genogram, tools
in FM, family life cycle stages

Analysis ( including Illness ( differential diagnosis, Disease and dysfunctions Population diagnosis: needs
differential diagnosis) stage of illness, compliance ( community effect on patient illness and vice
issues, bioethics versa), compare with epidemiological picture,
legislation ordinaces and policies
Social determinants of health

Assessment diagnosis Functionality/ Access thru health systems

dysfunctionality

Management Diagnostics / therapeutics Family intervention Improve access, networking linkages, referral
Prevention,supportive, Capability building of shared care, health education,
alternatives, self care caregivers,health education of COPC
Follow-up, referral,BPS family, reaasurance
 ASSIGNMENT
Choose a case you know at home and apply the PFC matrix. To be
submitted at the end of the month.
If you want to become a doctor, you need to learn to TREAT THE PATIENT AS WELL AS
THE DISEASE. ‘ IF YOUN TREAT A DISEASE, YOU WIN, YOU LOSE. IF YOU TREAT
A PATIENT, YOU WIN NO MATTER WHAT THE OUTCOME

• PATCH ADAMS
THANK YOU